Top

European Journal of Trauma and Emergency Surgery

Published in:

01-02-2021 | Angiography | Original Article

Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture

Authors: Hohyun Kim, Chang Ho Jeon, Jae Hun Kim, Hoon Kwon, Chang Won Kim, Gil Hwan Kim, Chan Kyu Lee, Sang Bong Lee, Jae Hoon Jang, Seon Hee Kim, Chan Yong Park, Seok Ran Yeom

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

Abstract

Background

While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture.

Methods

Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes.

Results

The median DTE time was 150 min (interquartile range, 121–184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20–3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04–1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28.

Conclusion

Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

Available only for authorised users

Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano R, Blackburn A, et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg. 2016;80(5):717–23. https://doi.org/10.1097/TA.0000000000001034 (discussion 23-5).CrossRefPubMed

Ghaemmaghami V, Sperry J, Gunst M, Friese R, Starr A, Frankel H, et al. Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. Am J Surg. 2007;194(6):720–3. https://doi.org/10.1016/j.amjsurg.2007.08.040.CrossRefPubMed

Hauschild O, Aghayev E, von Heyden J, Strohm PC, Culemann U, Pohlemann T, et al. Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register. J Trauma Acute Care Surg. 2012;73(3):679–84. https://doi.org/10.1097/TA.0b013e318253b5ba.CrossRefPubMed

White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;40(10):1023–30. https://doi.org/10.1016/j.injury.2008.11.023.CrossRefPubMed

Salcedo ES, Brown IE, Corwin MT, Galante JM. Pelvic angioembolization in trauma—indications and outcomes. Int J Surg. 2016;33:231–6. https://doi.org/10.1016/j.ijsu.2016.02.057.CrossRefPubMed

Vaidya R, Waldron J, Scott A, Nasr K. Angiography and embolization in the management of bleeding pelvic fractures. J Am Acad Orthop Surg. 2018;26(4):e68–76. https://doi.org/10.5435/JAAOS-D-16-00600.CrossRefPubMedPubMedCentral

Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5. https://doi.org/10.1186/s13017-017-0117-6.CrossRefPubMedPubMedCentral

Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture–update and systematic review. J Trauma. 2011;71(6):1850–68. https://doi.org/10.1097/TA.0b013e31823dca9a.CrossRefPubMed

Chu CH, Tennakoon L, Maggio PM, Weiser TG, Spain DA, Staudenmayer KL. Trends in the management of pelvic fractures, 2008–2010. J Surg Res. 2016;202(2):335–40. https://doi.org/10.1016/j.jss.2015.12.052.CrossRefPubMed

10.

Matsushima K, Piccinini A, Schellenberg M, Cheng V, Heindel P, Strumwasser A, et al. Effect of door-to-angioembolization time on mortality in pelvic fracture: every hour of delay counts. J Trauma Acute Care Surg. 2018;84(5):685–92. https://doi.org/10.1097/TA.0000000000001803.CrossRefPubMed

11.

Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF 3rd. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma. 1997;43(3):395–9. https://doi.org/10.1097/00005373-199709000-00001.CrossRefPubMed

12.

Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Harris I, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58(4):778–82. https://doi.org/10.1097/01.ta.0000158251.40760.b2.CrossRefPubMed

13.

Tanizaki S, Maeda S, Matano H, Sera M, Nagai H, Ishida H. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min. Inj Int J Care Inj. 2014;45(4):738–41. https://doi.org/10.1016/j.injury.2013.11.007.CrossRef

14.

Chou CH, Wu YT, Fu CY, Liao CH, Wang SY, Bajani F, et al. Hemostasis as soon as possible? The role of the time to angioembolization in the management of pelvic fracture. World J Emerg Surg. 2019;14:28. https://doi.org/10.1186/s13017-019-0248-z.CrossRefPubMedPubMedCentral

15.

Tesoriero RB, Bruns BR, Narayan M, Dubose J, Guliani SS, Brenner ML, et al. Angiographic embolization for hemorrhage following pelvic fracture: Is it “time” for a paradigm shift? J Trauma Acute Care Surg. 2017;82(1):18–26. https://doi.org/10.1097/TA.0000000000001259.CrossRefPubMed

16.

Lee R, Jeon CH, Kim CW, Kwon H, Kim JH, Kim H, et al. Clinical results of distal embolization in grade V splenic injury: four-year experience from a Single Regional Trauma Center. J Vasc Interv Radiol. 2020;31(10):1050-7.e2. https://doi.org/10.1016/j.jvir.2020.01.029 (Epub 2020 Apr 25).CrossRef

17.

American College of Surgeons Committee on Trauma. Advanced Trauma Life Support student course manual. 10th ed. Chicago: American College of Surgeons; 2018. p. 52–4.

18.

Morozumi J, Homma H, Ohta S, Noda M, Oda J, Mishima S, et al. Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. J Trauma. 2010;68(1):90–5. https://doi.org/10.1097/TA.0b013e3181c40061.CrossRefPubMed

19.

Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg. 2017;43(6):823–33. https://doi.org/10.1007/s00068-016-0744-8.CrossRefPubMed

20.

Costantini TW, Bosarge PL, Fortlage D, Bansal V, Coimbra R. Arterial embolization for pelvic fractures after blunt trauma: are we all talk? Am J Surg. 2010;200(6):752–7. https://doi.org/10.1016/j.amjsurg.2010.06.006 (discussion 7-8).CrossRefPubMed

21.

Hak DJ, Smith WR, Suzuki T. Management of hemorrhage in life-threatening pelvic fracture. J Am Acad Orthop Surg. 2009;17(7):447–57. https://doi.org/10.5435/00124635-200907000-00005.CrossRefPubMed

22.

Schwartz DA, Medina M, Cotton BA, Rahbar E, Wade CE, Cohen AM, et al. Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg. 2014;76(1):134–9. https://doi.org/10.1097/TA.0b013e3182ab0cfc.CrossRefPubMed

23.

Ito K, Nagao T, Tsunoyama T, Kono K, Tomonaga A, Nakazawa K, et al. Hybrid emergency room system improves timeliness of angioembolization for pelvic fracture. J Trauma Acute Care Surg. 2020;88(2):314–9. https://doi.org/10.1097/TA.0000000000002544.CrossRefPubMed

24.

Gansslen A, Giannoudis P, Pape HC. Hemorrhage in pelvic fracture: who needs angiography? Curr Opin Crit Care. 2003;9(6):515–23. https://doi.org/10.1097/00075198-200312000-00009.CrossRefPubMed

25.

Evers BM, Cryer HM, Miller FB. Pelvic fracture haemorrhage. Priorities in management. Arch Surg. 1989;124(4):422–4. https://doi.org/10.1001/archsurg.1989.01410040032006.CrossRefPubMed

Title: Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture
Authors: Hohyun Kim
Chang Ho Jeon
Jae Hun Kim
Hoon Kwon
Chang Won Kim
Gil Hwan Kim
Chan Kyu Lee
Sang Bong Lee
Jae Hoon Jang
Seon Hee Kim
Chan Yong Park
Seok Ran Yeom
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Angiography
Polytrauma
Polytrauma
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01601-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2022

Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries

A retrospective data analysis on the induction medications used in trauma rapid sequence intubations and their effects on outcomes

Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?

The horizontal shear fracture of the pelvis

Watercraft propellers as a mechanism of orthopaedic injuries: injury patterns, management, and complications

Using blood glucose and lactate levels for early detection of venous congestion following a free flap procedure for lower extremity open fractures